Provider Demographics
NPI:1922150457
Name:WARD, JODIE KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:KEVIN
Last Name:WARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 COWARDLY LION DR SUITE C
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6779
Mailing Address - Country:US
Mailing Address - Phone:304-754-9008
Mailing Address - Fax:304-754-0098
Practice Address - Street 1:71 COWARDLY LION DR STE C
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6779
Practice Address - Country:US
Practice Address - Phone:304-754-9008
Practice Address - Fax:304-754-0098
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice